1. Best Practices & Challenges GWH, Swindon perspective
Dr K Girish Gowda
Consultant Paediatrician
GWH, Swindon
Acknowledgement: Southwest Neonatal Network Dashboard

2. Overview GWH ATAIN trend Routine practices at GWH
GWH ATAIN Action Plan
Share good things/ Challenges

3. 2016 & 2017 ATAIN data
ATAIN 2016

4. Swindon ATAIN Trend

5. Swindon ATAIN Trend
Total Live births remain static but ATAIN rate is bit on the upper trend

6. 2017 Data (Per 1000 Live Births)

7. Practice in Swindon General Points
Antenatal Care:
Breast milk expression: two weeks prior to all elective C-section.
Robust antenatal care for diabetic patients
Antenatal Counselling with clear plan at delivery
Enthusiastic midwifery team and staff are good at following guidelines
Clear and easy to follow NEWS (Newborn Early Warning Score) chart

8. Practice in Swindon General Points
MSW (Midwife Support Worker) jointly look after babies on postnatal ward : one per shift.
Good working relationship between Maternity and Neonatal team
Monthly PAG (Perinatal Action Group) meeting – multidisciplinary team, discuss various issues including guideline approval

9. Practice in Swindon General Points
SCBU Nurses are good at challenging medical staff on unnecessary admissions.  
Consultant availability and support: Daily postnatal ward rounds in presence of midwife in-charge. Clear plan written notes.

10. Practice in Swindon Floor Plan- Good or Bad

11. Practice in Swindon Respiratory :
All elective LSCS before 39 weeks consider antenatal steroids.
Thermal Care : Delivery room optimal temperature, Baby Hat and skin to skin with proper covering baby with blankets.
Grunting babies at birth otherwise well: stay with mother but reviewed in 30 – 60 min
Registrars are encouraged to keep term babies on Delivery suite / post natal ward with frequent reviews and a clear plan.

12. Practice in Swindon Suspected Infection :
Early recognition and intervention as per NICE CG 149 All babies get “sepsis Identification Tool “ chart Antibiotic ward rounds – & 14.00hr Improved handover - Baby’s details on Handover sheet with a clear plan
Term Admission per 1000 Live Births

13. Sepsis Identification Tool Chart

14. Practice in Swindon Hypoglycaemia:
MatNeo Wave 2 – Awaiting implementation of BAMP guideline
Proposed changes are:
Reduced threshold of BS from 2.6 to 2.0
Dextrose gel
Large babies are excluded
Strict on when to do blood sugar, e.g before second feed
Term Admission per 1000 Live Births

15. Practice in Swindon Suspected HIE

16. Practice in Swindon Suspected HIE
Term Admission per 1000 Live Births
18.4
12.5

17. Lets look at the southwest HIE Pathway and the inclusion criteria for CFM

18. Continued resuscitation at 10 mins
These are main inclusion criteria. Say what it is….

19. Swindon Audit 2017: Cooling Criteria
This is a busy slide. Out of these 10 babies only two had Therapeutic hypothermia.
There is a poster on the audit happy to take more question over there…

20. Suspected HIE between Networks

21. Post-natal ward / TC
Lot of these babies come under TC as per recent BAPM TC FARMEWORK guideline. Midwifery team have culture of open mindedness and will do extra mile in the best interest of babies and family.

22. “More than normal care” on PNW
Interesting fact is that depending on care location the tariff changes. Example is these babies are looked after in SCBU they get HRG 3 and more money but in fact more work and time spent to kee babies and mother together but these babies get HRG 4 or 5 and less money…

23. Outcome/Success Criteria
ATAIN – Action Plan 2018/19
Sl No.
Aim/Objectives
Action
Outcome/Success Criteria 1
To improve the accuracy of data input on Badger by ensuring we (GWH) comply with and record in line with the NNMDS (National Neonatal Minimum Data Set)
This highlighted the need for a Admin staff: Data Analyser
Employing data analyser.
No “missed data” or “inaccurate data” on badger. 2
Minimise admission of babies with HIE.
Retrospective Audit – to study the most common reasons and implement measures as needed.
Continue the current project of “Each Baby Counts” & “Saving Babies’ Lives”.
Learn from individual cases.
Reduction in babies needing CFM or cooling
Completed Audit :
a. “HIE Care Bundle“
b. Network to revisit / revise
Current HIE guideline

24. Proposed “HIE / Neonatal Neuro-Protection (NNP) Care bundle”

25. Outcome/Success Criteria
ATAIN – Action Plan 2018/19
Sl No.
Aim/Objectives
Action
Outcome/Success Criteria 3
Mandatory e-learning on “Avoidable Term Admission” (RCPCH accredited). Available via Training Tracker
Staff to be made Aware of this by , newsletter, poster.
To cover this on Induction for new staff
Audit to show how many have completed the training module this year. Aim for 80% completion.
? 4
2017 data shows, 27% of all term admissions staying less than 24hrs
Aim to reduce this to <20% by next year.
Retrospective audit on these babies and implement measure to minimise this
Implementing the learning points from the audit results.

26. Something to Celebrate / Share
Good ATAIN rate
Good NNAP 2016 / 2017
Good MBBRACE on still births 2016/17
Nursing recruitment
BadgerNet Admin Staff
Extended & robust Outreach SCBU Nursing Services
Monthly Coffee morning run by Parents / SCBU nurse
Improved quality of BadgerNet daily summary (entered by Nursing staff)
Challenges:
Split Tier 1 (SHO) Rota
Quality of Badger Discharge letters (Doctors complete it)
To keep our ATAIN target at the current rate.
TC implementation

27. ATAIN TEAM Swindon ATAIN core Team:
Neonatal Consultant ATAIN lead: Dr Gowda (GG)
Obstetric Consultant ATAIN lead : Dr Sinha (AS)
Senior Midwifery Team ATAIN lead: Mrs Kathryn Owen(KO)
Senor Midwife: Karin Jones (KJ)
Senior Neonatal Nurse : Mrs Nikki Taylor (NT)
SB – Dr. Sarah Bates, Consultant Paediatrician/Neonatologist
STZ- Dr. Stanley Zengeya, Consultant Paediatrician/Neonatologist
CG – Cathy Gale, Breast feeding co-ordinator midwife
JE- Julie Edwards, Sister in charge on DAU
AM – Alison Morton, Sister In charge on Day Assessment Unit
EC – Emma Churchill, Service Manager Women and Children Division
RM- Rob McKinlay, Data Quality Administrator and Risk Management
GT- Gemma Texeira, Data Quality Administrator
DJ- Donna Johnson, Midwife
JH- Julie Herring, MSW

28. Thank you